Individual
DR. RAMANUJA R MANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD FACC FCCP
Contact information
Practice address
6308 8TH AVE, STE 3060, KENOSHA, WI 53143-5082
(262) 656-8271
(262) 656-8255
Mailing address
6308 8TH AVE, STE 3060, KENOSHA, WI 53143-5082
(262) 656-8271
(262) 656-8255
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
27743
WI
207RI0011X
Interventional Cardiology Physician
27743
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407830698
—
WI
05
—
30745100
—
WI
Enumeration date
12/01/2005
Last updated
09/15/2009
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